Medrinal, Clément; Gillet, Alexis; Boujibar, Fairuz; Dugernier, Jonathan; Zwahlen, Marcel; Lamia, Bouchra; Girault, Christophe; Creteur, Jacques; Fellrath, Jean-Marc; Haesler, Laurence; Lagache, Laurie; Goubert, Laure; Artaud Macari, Elise; Taton, Olivier; Gouin, Philippe; Leduc, Dimitri; Van Hove, Olivier; Norrenberg, Michelle; Prieur, Guillaume; Combret, Yann; ... (2021). Role of Non-Invasive Respiratory Supports in COVID-19 Acute Respiratory Failure Patients with Do Not Intubate Orders. Journal of clinical medicine, 10(13), p. 2783. MDPI 10.3390/jcm10132783
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The current gold-standard treatment for COVID-19-related hypoxemic respiratory failure is invasive mechanical ventilation. However, do not intubate orders (DNI), prevent the use of this treatment in some cases. The aim of this study was to evaluate if non-invasive ventilatory supports can provide a good therapeutic alternative to invasive ventilation in patients with severe COVID-19 infection and a DNI. Data were collected from four centres in three European countries. Patients with severe COVID-19 infection were included. We emulated a hypothetical target trial in which outcomes were compared in patients with a DNI order treated exclusively by non-invasive respiratory support with patients who could be intubated if necessary. We set up a propensity score and an inverse probability of treatment weighting to remove confounding by indication. Four-hundred patients were included: 270 were eligible for intubation and 130 had a DNI order. The adjusted risk ratio for death among patients eligible for intubation was 0.81 (95% CI 0.46 to 1.42). The median length of stay in acute care for survivors was similar between groups (18 (10-31) vs. (19 (13-23.5); p = 0.76). The use of non-invasive respiratory support is a good compromise for patients with severe COVID-19 and a do not intubate order.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM) 04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Rheumatology and Immunology 04 Faculty of Medicine > Faculty Institutions > Teaching Staff, Faculty of Medicine |
UniBE Contributor: |
Zwahlen, Marcel |
Subjects: |
600 Technology > 610 Medicine & health 300 Social sciences, sociology & anthropology > 360 Social problems & social services |
ISSN: |
2077-0383 |
Publisher: |
MDPI |
Language: |
English |
Submitter: |
Andrea Flükiger-Flückiger |
Date Deposited: |
07 Jul 2021 23:07 |
Last Modified: |
04 Apr 2024 14:57 |
Publisher DOI: |
10.3390/jcm10132783 |
PubMed ID: |
34202895 |
Uncontrolled Keywords: |
COVID-19 CPAP high flow nasal cannula mechanical ventilation oxygenation |
BORIS DOI: |
10.48350/157389 |
URI: |
https://boris.unibe.ch/id/eprint/157389 |
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